Endometriosis, a disease affecting approximately 10% of the female population, requires laparoscopy and histologic confirmation for diagnosis. Laparoscopic recognition of endometriosis lesions can be extremely challenging even for the experienced surgeon due to the protean appearances of endometriosis. Visual appearance of what is classically described as pigmented, dark lesions are easily spotted while the non-pigmented, more prevalent white lesions, also known as “subtle” lesions, pose difficulty for recognition. This is due to a wide unrestricted light spectrum, light reflection, and gas pressure used in laparoscopic surgery. An endometriosis surgeon should be familiar with all appearances of endometriosis. The classical or typical lesions are quickly visualized with varying colors from red to black, but they are always outnumbered by atypical and microscopic endometriosis, which is not easily recognized. The inexperienced surgeons who do not practice excision technique may miss these occult and deep lesions. A wide variety of angiogenesis and inflammatory process is taking place in the peritoneum and must be recognized in addition to the typical and atypical lesions of endometriosis. Laparoscopy may be performed via the abdominal wall and the peritoneal cavity or via the vagina and the pouch of Douglas. The benefit of this second route of entry for the patients is that the intervention is minimally invasive, with no scar and performed typically under local anaesthesia. This procedure is deemed to be safe because it is carried out entirely below the peritoneum, eliminating the risk of peritonitis if the bowel is inadvertently punctured. In addition the procedure is carried out without disturbing the position of the internal organs, thus allowing the detection of abnormalities normally not seen during conventional laparoscopy.
In gynecology, diagnostic laparoscopy may be used to inspect the outside of the uterus, ovaries and fallopian tubes, for example in the diagnosis of female infertility or endometriosis. Usually, there is one incision near the navel and a second near to the pubic hairline. During laparoscopy, the abdominal cavity is pressurized using a gas, typically carbon dioxide, for providing a better view to the surgeon. US20130131457 A1, which is incorporated here by reference, describes a procedure via the vagina and the pouch of Douglas and an instrument thereof for eliminating the risk of a puncture or injury e.g. to major blood vessels.
US20130131457 A1, which is incorporated here by reference, describes a further instrument for introduction through trans-vaginal route and the use of a liquid for pressurizing the pelvic cavity instead of a gas. Such a liquid may typically be a saline solution such as normal saline (0.90% w/v of NaCl, about 300 mOsm/L or 9.0 g per liter).
There is still a need for enhancing the view of the surgeon during a laparoscopy, especially for inspection for superficial collateral pathology, Leopard Spots; inspection for retroperitoneal fibrosis and inspection for micro endometriosis implants.